The expanding role of nurses in surgery and prescribing in British departments of dermatology. Therapy Guidelines and Audit Subcommittee of the British Association of Dermatologists.

Abstract

A questionnaire to all 463 consultant members of the British Association of Dermatologists regarding nursing developments received 183 responses (40%) from over 127 departments. Sixty-nine per cent of respondents have nurse-run clinics, anticipated to increase to 91% at base hospitals and 79% in community settings. Fifty-seven per cent have protocols for nurses to alter treatments; 20% have nurses who initiate treatments. Twenty-six per cent have nurses who prescribe with medical countersignature, and 5% have nurses who can prescribe without medical countersignature (likely to increase fourfold). Seventy-two per cent anticipate nurses administering cryotherapy within the next few years. Few respondents supported nurses treating malignancies or lesions not seen by a dermatologist, but supervised procedures such as curettage, shave biopsy and punch biopsy were all likely to increase from about 15% to 30-40%. These interventional procedures, and particularly prescribing without medical countersignature, were currently most frequent in units without specialist registrar support. Obstacles to extending nursing roles included opposition from administration or nursing hierarchies (about 40%), funding problems (about 25%) and uncertainties from departmental nurses themselves (17%). There is clearly support from dermatologists for these developments, but the importance of adequate training, protocols and support from all relevant staff is paramount.